Healthcare Provider Details

I. General information

NPI: 1316795263
Provider Name (Legal Business Name): SOHEL SHAKILAHAMED SOUDAGAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 UNIVERSITY HOSPITAL DR. RM. 714
MOBILE AL
36617-2293
US

IV. Provider business mailing address

2451 UNIVERSITY HOSPITAL DR. RM. 714
MOBILE AL
36617-2293
US

V. Phone/Fax

Practice location:
  • Phone: 251-471-7117
  • Fax:
Mailing address:
  • Phone: 251-471-7117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL.6391R
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: